Russia has been making reforms to its healthcare system but until now these have focused almost entirely on dealing with its demographic decline and boosting pre-natal and maternity care. The rest of the system has been barely touched since the 1950s and half the hospitals have been closed over the last decade. Can Russia cope with an explosion of the coronavirus (COVID-19)?

So far, the official number of people infected in Russia is low – surprisingly low. Since the first case was reported on February 24 the number has climbed to 659 confirmed cases as of March 25, but that was already a leap up from the 438 cases reported 24 hours earlier.

Russia has been an outlier in terms of the case count vs the number of tests it has conducted, but as the Moscow Times reported, there are questions over the accuracy of its testing equipment: the equipment is reportedly not as sensitive as those other countries have been using.

The authorities are finally waking up to the danger. The media has reported that while the numbers of coronavirus cases is low, the number of pneumonia cases, which often result from coronavirus infection, has soared by 40% in Moscow in the last month.

Moscow Mayor Sergey Sobyanin met with Russian President Vladimir Putin at the start of this week and warned him that the number of cases was likely to be “much higher than the reported number.” Putin went on TV on March 24 and put the whole country on holiday for a week on full pay from March 30 as well as introducing a raft of other support and health measures. Pensioners over the age of 65 have already been told to stay home, and while Moscow, where most of the cases are concentrated, is not on lockdown, most public spaces are closed. Against that, reports show that bars and restaurants around the country are still open, as the population has yet to adopt social distancing.

Experts worry that Russia is ill-prepared to deal with a spike in infections thanks to the neglect of health system reform.

Minister of Health Veronika Skvortsova said on March 24 that “nobody has touched systemically the medical infrastructure since the end of the '50s,” as cited by Russian daily RBC.

The Kremlin has admitted as much by launching a project two weeks ago to build a new hospital in Moscow to treat those infected by the coronavirus that is supposed to be completed in under two months. Construction is already well underway. Since then, plans for several other new hospitals in the regions have been announced.

Finance Minister Anton Siluanov also commented this week, saying: “The topic has not been resolved for years. The modernisation of polyclinics, district hospitals [is necessary], which are in poor, if not terrible, condition."

The Kremlin has not ignored the health sector. The problem is that it has focused on a relatively few areas and the reforms are incomplete.

Healthcare reform began in 2010, when the law on compulsory health insurance was passed, according to David Melik-Huseynov, director of the research institute of the health organisation at the Moscow Department of Health, as cited by RBC.

It was supposed to optimise costs by closing down inefficient hospitals and expanding the use of high-tech medical facilities. Similar measures began in 2003-2005.

As a result of the optimisation, experts at the Centre for Economic and Political Reforms (CEP) calculated in 2017, based on Rosstat data, that from 2000 to 2015 the number of hospitals in Russia halved from 10,700 to 5,400. The number of clinics decreased by 12.7% to 18,600 institutions in the same period.

Specialists then noted that if the rate of hospital closure was maintained (approximately 353 annually) by 2021-2022, the number of medical facilities in the country would reach 3,000, that is, the level during the Russian Empire in 1913.

Public health and health facilities featured prominently during Putin’s annual call in January and the poor state of facilities was highlighted. Investment into things like hospitals is part of the 12 national projects that is top of the Kremlin’s agenda for Putin’s current term in office, but that work got off to a slow start last year.

Now Russia runs the risk of being caught out. The state has been closing inefficient and out-of-date facilities, but has not got round to building new ones to replace them. Given the infection rate is starting to grow exponentially, the Russian health system is real danger of getting overwhelmed very soon.